ENDOBRONCHIAL HAMARTOMA

Abstract

SESSION TITLE: Procedures SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Benign tumors of the lung constitute a small portion of all lung neoplasms with Hamartoma being the most common. Hamartoma is a rare benign tumors consisting of multiple mesenchymal cell lines CASE PRESENTATION: 56 Years Old woman presented with abnormal CT chest finding with left upper lobe lung nodule. An incidental finding of right middle lobe endobronchial lesion causing nearly full obstruction of the right middle lobe was seen (figure). The patient endorsed mild dyspnea on exertion with on and off productive cough with clear sputum. The patient denied any fever or chills, weight loss or change in her daily activity. The CT chest compared with a previous images 6 months ago and confirmed the finding of same size right middle lobe endobronchial lesion. Bronchoscopy performed and confirmed the findings of right middle lobe smooth polypoid endobronchial lesion (figure). Hot snare used to debulk the lesion. The lesion removed with no signs of bleeding or blood oozing and tissue sent for pathology. The pathology demonstrated a mix of fat, cartilage and smooth muscle with no evidence of malignancy. DISCUSSION: Pulmonary hamartomas are well known to be the most common benign lung neoplasm with incidence in the general population estimated to be 0.25% and male to female ratio 2:1 to 4:1. According to Bateson; 80.5% of pulmonary hamartomas were intrapulmonary and 19.5% were endobronchial while others like Joseph stated 10.3% were endobronchial and Arrigoni said only 3% were endobronchial. 54.5% of endobronchial hamartomas occur on the right side of the lung while 45.5% occur on the left side. Pulmonary Hamartoma contains mesenchymal and epithelial elements that differentiates into chondroid, adipose and smooth muscle cells. A hamartoma is distinguished from other benign tumors like Chondromas or Lipomas by the presence of at least two mesenchymal elements as compared to the former, which have only one mesenchymal element. Several investigators have reported an association with Carney’s syndrome which consists of chondromatous hamartoma of the lung, extra adrenal paraganglioma, and gastric leiomyosarcoma.Patients with intrapulmonary hamartomas are usually free of symptoms while endobronchial lesions cause variety of symptoms due to bronchial irritation and obstruction which include cough, fever, wheezing, dyspnea and hemoptysis. Complications like post obstructive pneumonia and atelectasis occur. CONCLUSIONS: In conclusion, endobronchial hamartomas are benign neoplasms of the tracheobronchial tree. Endoscopic treatment with flexible bronchoscopic electrocautery is safe and less invasive in experienced hands. Therefore, it should be considered as the primary treatment approach in selected cases. Reference #1: Tomashefski, J. F. 1982 Benign endobronchial mesenchymal tumors: their relationship to parenchymal pulmonary hamartomasAm J Surg Pathol Reference #2: Arrigoni, M. G. 1970 Benign tumors of the lung. A ten-year surgical experienceJ Thorac Cardiovasc Surg Reference #3: The conventional treatment for hamartomas is usually surgical removal due to potential malignant transformation although conservative measures in the form of endoscopic excision can be applied in the absence of chronic post-obstructive lung injury. Most solitary subpleural hamartomas may be removed by enucleation. A wedge resection can be useful if the tumor has become inflamed and involved contagious structures. If the lung distal to the obstruction is irreversibly damaged, lobar resection or even pneumonectomy may be indicated. DISCLOSURES: No relevant relationships by Abdul Hamid Alraiyes, source=Web Response No relevant relationships by Mohamed Elrifai, source=Web Response No relevant relationships by Arun Kadamkulam Syriac, source=Web Response